Friday, 16 December 2011

Addiction Treatment Is Not a Cure for Addiction: Why Relapse Is So Common

Every time I hear that another celebrity has died from addiction to drugs or alcohol, my first thought is -- why didn't anybody care enough to help? It's instinctual and I am often humbled later when I discover that people did actually try to help...sometimes more than once. Yet, the next time somebody dies I find myself asking the same question again and, inevitably, run into the same troubling answer. The fact is, many people who die from substance abuse, whether from an overdose or long-term systemic toxic damage, usually have entered rehab (sometimes more than once) and gotten clean for at least some period of time. Yet, they still end up dying from their disease.
 
As I see it, the problem is three-fold. First, current best practices in addiction medicine advocate a period of treatment that is far too short to effectuate long-term recovery for many patients (actually, the recommended treatment is based on what insurance carriers are willing to cover). Second, once a patient has recovered we assume they are cured and fail to adequately plan for inevitable relapse. Finally, there may be people in the addict's life who benefit more from the person's active addiction than recovery.
 
Treatment Periods Are Inadequate
 
Although the standard "28-day" rehab has, over the years, steadily climbed to the emerging "90-day" program, it is still too short for many patients. Unfortunately, these "recovery" periods are often dictated by finances or insurers and have little to do with what the patient actually needs. In the case of celebrities who can afford longer treatment, it is hard to convince them they need more than what insurance-dependent addicts typically get. They often fear they will harm their career if they stay out of the spotlight for too long.
 
Addiction treatment entails much more than just getting the patient to stop using drugs or alcohol. For most patients, the abuse will re-occur unless they can understand both why they became addicted in the first place and how they can prevent it from happening again. And, even then, relapse is still likely. Given this reality, it is bizarre to think that years and even decades of substance abuse could be adequately addressed in a month or two of treatment.
 
Instead of viewing addiction as a chronic, life-long disorder (like diabetes or heart disease) that needs long-term follow-up treatment, the current model equates the initial treatment as the "cure" and leaves the patient to figure it out for themselves after that. However, without long-term monitoring, the support of ongoing therapy, and peer-support found in SMART Recovery or 12-step meetings, the chances of resuming bad habits when back in the "real" world seem inevitable, especially when we consider that addiction is marked by nearly insurmountable physical cravings. It is no wonder that the success rate of "treatment" is so abysmally low: we have made treatment a discrete period of time rather than an ongoing process. We don't have regular "check-ups" like we do for other diseases and we certainly don't have any consensus on long-term maintenance like we do for heart disease and other life-long ailments.
 
The Need for Ongoing Support & Treatment
 
Even with an adequate length of treatment and the availability of follow-up support, ongoing recovery requires co-operation from family, friends, and sometimes even employees or employers. If everybody is not onboard with lasting sobriety, even the most motivated person can relapse. Due to the level of media interest, we see this phenomenon most often with celebrities. In some cases, people want to keep an addict using because it benefits them. In other cases they are too afraid of angering the addict to intervene in ongoing substance abuse. The allure of being part of the celebrity's inner circle can create quite a moral hazard.
 
When a celebrity or wealthy person is battling addiction, we see both opportunists and yes-men. The opportunist benefits from active addiction either because the person is easier to get along with or easier to manipulate. This is especially true when a person close to the addict is getting away with something (such as embezzlement) or controlling a situation that would not be possible if the celebrity were clear-headed and sober. The yes-man does not want to do anything that would make them fall out of favor with the celebrity and cause them to lose their position, be it a family member, friend or employee. While yes-men often see that there is a problem that needs to be addressed, their own short-sighted self-interest will prevent them from doing anything about it.
 
Unfortunately, many celebrities become quite comfortable with an entourage of yes-men or sycophants who protect them from the realities of their behavior. If they are insecure they crave attention from people who would do anything to be in their presence. If they are addicted they are drawn to people who will look the other way or make their addiction easier by obtaining drugs for them. While most people would soon find themselves friendless or out of funds, celebrities can behave very badly for much longer.
 
Is Relapse Inevitable?
 
The truth is, relapse is part of recovery for many with addiction. The attitude has thus-far been "treatment failed." The truth is drug rehab treatment was probably too short and follow-up care is largely nonexistent in the addiction medicine field. As a society we have long bemoaned the costs of addiction, yet we have done little to change attitudes. The medical community has pushed addiction treatment into a sub-sub-specialty that is so "specialized" most doctors get zero training in identifying or intervening when a patient develops an addiction. We have mainly paid lip service to the disease model of addiction and still consider it "willful negligence" or some sort of moral failing. This approach has clearly failed. Until we truly change our attitudes, relapse will indeed, for most, be inevitable.


2 comments:

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  2. Addiction treatment entails much more than just getting the patient to stop using drugs or alcohol. For most patients, the abuse will re-occur unless they can understand both why they became addicted in the first place and how they can prevent it from happening again.Florida addiction interventions

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